Better BP

Better BP Programme

The Better BP Programme is designed to give an accurate , reproducible measurement on blood pressure, identify the causative factors, and formulate a management programme for optimal control.  We manage the Programme in six steps.

Step:1 Better BP Measurement
Automated Office BP (AOBP)

A programmable device, such as the Omron series, is utilised. This can produce consistent readings in an appropriate environment: the doctor or nurse can leave the room, thereby eliminating conversation which, in itself, can elevate blood pressure reading by up to 20 mm Hg.

 

Omron

Our procedure is:

  1. Programme an Omron (or similar) device;
  2. 3 minute rest with doctor or nurse out of the room;
  3. 3 readings 1 min apart – averaged;
  4. Repeat if systolic readings vary by more than 20 mm.

 

Step 2 : Better All Day BP -24 Hour BP

24-Hour Blood Pressure Monitoring determines what BP does over a full day – not just in the doctor’s rooms.
In the case below, persistent hypertension is confirmed.

Ambulatory BP

Step 3: Better Basics-finding the Why of BP
Control of blood pressure lies in the Stress in our Nervous System and the Stretch in our Arteries
These factors are estimated by:

Heart Rate Variability
Pulse Wave Analysis
  • Heart Rate Variability (HRV): this is a five-minute test of resting heart rate, and measures the nervous activity in the body.

 

 

 

 

 

 

 

  • Pulse Wave Analysis (PWA): this measures the wave form of the pulse at the wrist, and allows an estimation of:central pressure at the heart, which is a more important indicator than the arm pressure; and arterial compliance which, through analysing wave reflection from the periphery, measures the tone of the artery which controls blood pressure.

 

 

 

 

 

 

 

Step 4 : Better Risk Management- What is my Risk?
Absolute Cardiovascular Risk is then calculated to determine if an individual is low, moderate or high risk
A blood test gives information regarding kidney function, cholesterol and possible diabetes.

Then an  electronic risk calculator incorporating age gender , smoking history gives a result in the green ,

orange or red zone.

A target blood pressure is set:

  • The normal target is under 140 /90
  • (For those with heart disease,  or diabetes the target is 130 / 80);
  • if kidney impairment is present the target is 120/80.

 

Step 5: Better Choices -A Logical Approach to Medication

Therapy is based on the causative factors identified through  Heart Rate Variability , and Pulse Wave Analysis and Absolute CV Risk:

  • Autonomic Dysfunction, as determined by HRV: implies agents which block adrenaline -b-blocker or Physiotens therapy;
  • Abnormal Arterial Compliance, as determined by Pulse Wave Analysis: implies agents which act on arterial tone, such as Angiotensin Receptor Blockers (ARB), for example Micardis or Atacand; or Calcium Channel Blockers ( CCBs), for example Zanidep ,and Norvasc; or combined therapy may be required. (CCBs are favoured for Variable Hypertension).
  • Central pressure alone is elevated: implies diuretic therapy (for example Natrilix) alone, or in combination.

Most modern agents have minimal side effects, can be used in combinations of two or three agents in a single tablet , and rarely, if ever, produce too low a blood pressure. It is, nevertheless, essential that an adequate fluid intake be maintained when exercising, or in  humid conditions.

 

Step 6: Better Backup 

Subsequent steps in our follow-up are:

  • monthly – AOBP monitor to target brachial BP;
  • 3 months – ECG, PWA, pathology;
  • 6 months – Automated Office BP (AOBP);
  • 9 months – AOBP;
  • 12 months – AOBP, CV review, risk score, PWA.

Generally, our goal (target) BP is obtained within six weeks. Our results in the Viper Study gave an 88% success of treatment to target.

Top